Monday, June 15, 2009

The recent legalization of euthanasia in Luxembourg has already resulted in a change to the role of palliative care in the tiny European nation.Under the title: New Guide for Palliative care in Luxembourg, the information states:

A booklet has just been produced in Luxembourg explaining the new law that was passed on March 16th, relating to palliative care and end of life support, which is renowned from the law on euthanasia and assisted suicide. Information and documentation are being produced under the leadership of the National Commission on audit and evaluation set up to oversee the implementation of the law on euthanasia and assisted suicide of terminal or serious and incurable diseases.

The role of palliative care has been changed in the new guide to include: The provision of a substance to end life.

Grand Duke Henri

The legalization of euthanasia in Luxembourg resulted in a constitutional crisis because Grand Duke Henri of Luxembourg refused to sign the bill into law forcing the Duchy of Luxembourg to change its constitution by removing the power of the Grand Duke to sign legislation before it becomes the law of the land.Grand Duke Henri argued that the legalization of euthanasia was unnecessary because the fear of suffering for people with terminal conditions can be effectively treated by palliative care. He further argued that it was unjust to legalize the practise of killing people and that his conscience could not permit him to sign such a bill into law.The newsreport went on to say that:

The aim of this "Guide to Palliative Care" is to explain the basic principles and key provisions of the law relating to palliative care, the advance directive and support purposes only. It also summarises the various possibilities that already exist or are under development.

Friday, June 12, 2009

• Bill C-384 would legalize euthanasia and assisted suicide in Canada. (For the purpose of the analysis, euthanasia and assisted suicide will be referred to as “intended death”.)• Bill C-384 does not restrict intended death to Canadian citizens. (The bill could make Canada a destination for Suicide Tourists and Suicide Clinics).• The person would need to be at least 18 years old. • The person may refuse appropriate treatments and still die by an intended death. (A medical practitioner cannot determine that there is no prospect of relief from pain if the person refuses appropriate treatments).• Bill C-384 allows intended death for people who experience depression or other chronic mental conditions.• Bill C-384 does not limit intended death to the terminally ill and it does not define terminal illness.• Bill C-384 measures competency based on “appearing to be lucid”. The term “appearing to be lucid” does not assure that the person is actually lucid.• Bill C-384 would allows intended death for incompetent people stated while competent their intentions. • The language of the bill is not clear whether medical practitioners are the only persons who can intend the death of an incompetent person.• Bill C-384 would requires at least two medical practitioners to confirm the diagnosis in writing. (The bill does not prohibit doctor shopping).• Bill C-384 would require that all requests for intended death be made free of duress. (This is an illusion. No assurances are built into the bill)• Bill C-384 would require the medical practitioner to inform the person of all alternatives. (There is no requirement to try effective treatments). • Bill C-384 would assure that the person may revoke their request at any time. (This is an illusion. This bill allows for the intended death of incompetent people.)• Bill C-384 would require the medical practitioner to provide confirmation of the diagnosis to the coroner. This is a form of after-the-fact reporting. The medical practitioner is only required to a file a report after the person has died. This is only a safeguard for the medical practitioner and not the person who is dead.• The definition of medical practitioner is not limited to a physician.

Section 222 is the homicide provision within the criminal code. Bill C-384 legalizes euthanasia by amending subsection 222(7) of the Criminal Code.

Euthanasia is a deliberate act undertaken by one person with the intention of ending the life of another person to relieve that person’s suffering, where the act is the cause of death. (Of Life and Death - 1995)

Assisted suicide is the act of intentionally killing oneself with the assistance of another who provides the knowledge, means or both. (Of Life and Death - 1995)

Bill C-384 amends the Criminal Code by adding to subsections 222(7) and 241(2) exceptions whereby the law is circumvented.

• Bill C-384 states that the person must be at least eighteen years old. This “safeguard” may be unconstitutional because it limits what is determined by the bill to be appropriate medical treatment only based on the age of the person. Since the constitution recognizes that everyone is equal under the law, therefore it may be unconstitutional to limit the rights of individuals, based on age, without good reason.

• Bill C-384 states that the person is eligible: “after trying or expressly refusing the appropriate treatments available that they continue to experience severe physical or mental pain without any prospect of relief.”

A person is eligible if they experience severe physical pain without any prospect of relief.

Physical and mental pain can always be mitigated. Modern palliative care has substantially improved over the past 30 years. Medicine has not solved every concern with pain and symptom management, but the concept of experiencing physical pain without any prospect of relief is a sign of a patient who has not been appropriately cared for and not a reason for intended death.

Bill C-384 directly threatens the lives of people with disabilities and/or people with chronic conditions. People with disabilities and chronic conditions are often perceived as being without any prospect of relief. These same people will usually view their life experience differently from those who are making judgement of their quality of life.

A person is eligible if they experience severe mental pain without any prospect of relief.

Chronic depression and mental pain is always treatable. Further, one must question the concept of intending the death of a person who experiences chronic depression or mental pain because you can never be sure that the person is competent to consent. Remember the bill states you must only “appear to be lucid.”

Bill C-384 does not require medical practitioners refer people with mental pain to a specialist.

Since a person is eligible if they have refused appropriate treatments that are available. How can a medical practitioner determine that the mental pain has no prospect of relief if the person can refuse appropriate treatments?

• The bill states that the person is eligible if: they suffer from a terminal illness. Bill C-384 does not define terminal illness.

Many people live with a terminal illness but are not actively dying. My step-father died 28 months after he was diagnosed with terminal cancer and given 6 months to live.

Bill C-384 would have qualified my step-father for an intended death when he was diagnosed.

• Bill C-384 states that the person is eligible if: “the person has provided a medical practitioner, while appearing to be lucid, with two written requests more than 10 days apart expressly stating the person’s free and informed consent to opt to die.”

The assumption that someone is competent when they “appear to be lucid” is questionable at best. To appear to be lucid cannot be considered an appropriate measure for competency. In other words, Bill C-384 would allow an intended death upon someone who may not actually be competent.

The safeguard related to making two written requests more than 10 days apart is to prove the lasting intent of the person. This safeguard is an illusion because the person who makes the request only needs to “appear to be lucid”.

• Bill C-384 states that if: “the person has designated in writing with free and informed consent, before two witnesses with no personal interest in the death of the person, another person to act on his or her behalf with any medical practitioner when the person does not appear to be lucid”.

This means that a person can have an intended death if they have made the request in a valid advanced directive.

It is unclear whether the person who does the act of intended death of the incompetent person must be a medical practitioner. The bill states that “another person can act on his or her behalf with any medical practitioner when the person does not appear to be lucid.” Because the bill states that another person can act on his or her behalf with any medical practitioner, therefore it is unclear whether or not that means that the act referred to is the intended death or consenting to the intended death.

• Bill C-384 requires that written confirmation of the diagnosis has been received from at least two medical practitioners. The bill does not preclude the practice of doctor shopping. In the state of Oregon, people who are denied assisted suicide from one doctor will be referred to another doctor by Compassion & Choices. In 2008, 53 of the 60 assisted suicide deaths in Oregon were facilitated by the lobby group Compassion & Choices.

• Bill C-384 requires “the medical practitioner to assure that there are no reasonable grounds to believe that the written requests for euthanasia and assisted suicide were made under duress or while a person was not lucid.”

This safeguard is designed to guarantee competency. This safeguard is an illusion because the person making the request only needs to “appear to be lucid”.

• Bill C-384 requires that “the medical practitioner has informed the person of the consequences of the request for euthanasia or assisted suicide and of the alternatives that are available to the person.”

This supposed safeguard is designed to guarantee that the person is aware of the available options. This safeguard is an illusion because the person is not required to try effective treatments and there is no requirement to refer the person to a palliative care specialist.

• Bill C-384 requires “the medical practitioner to act in the manner indicated by the person and that the person may revoke their request at any time.”

This simply means that a person may change their mind at any time. This supposed safeguard is an illusion because the bill allows for an intended death after the person is deemed incompetent, as long as the person had requested an intended death while being competent.

• Bill C-384 requires “the medial practitioner to provide the coroner with a copy of the written confirmations of the diagnosis that were received from at least two medical practitioners.”

This is a common “after-the-fact” reporting system that exists in other jurisdictions where they have legalized an intended death. After-the-fact reporting is not a safeguard because the person has already died, it only offers protection for the medical practitioner.

• Bill C-384 defines medical practitioner as a duly qualified person by provincial law to practice medicine. The definition of medical practitioner is not limited to a physician.

Final comments:

• Society cannot legislate autonomy and choice in relation to acts that intentionally and directly cause death. No safeguard will ever protect vulnerable people from the subtle pressure to “choose” death.Legalizing euthanasia and/or assisted suicide is always wrong because: • It directly and intentionally threatens the lives of the most vulnerable members of society. The lives of people with disabilities and chronic conditions, people who live with depression and mental illness, and others are directly threatened by euthanasia and assisted suicide. • It establishes euthanasia and assisted suicide as a treatment option for problems that are properly solved by effective and compassionate medical care.• It changes the trust relationship between the medical practitioner and the patient.

Canadians need to tell their member of parliament to vote against Bill C-384 because it promotes a concept of choice and autonomy which is based on false principles and safeguards that are simply an illusion.